Presentations of the face and neck

Mumps, trauma and sebopsoriasis. By Dr Philip Marazzi

Bell's palsy

This 40-year-old man presented with the classic picture of Bell's palsy affecting the right side of his face. This is a fairly straightforward diagnosis. It should not, however, be confused with an upper motor neuron lesion, which has a similar symptom pattern but spares the forehead wrinkling on the ipsilateral side. Most cases are idiopathic and resolve spontaneously, although steroids and antivirals are often used 'in case'.


 

Erysipelas

This woman presented with a rapidly spreading red rash on her face. She was quite ill, with a high fever. She had already been started on oral flucloxacillin the day before, so was admitted for IV antibiotics. The causative organism is usually a streptococcus and in her case, the addition of co-amoxiclav rapidly controlled the infection.


 

Sebopsoriasis

This woman presented with a rash in a butterfly-type distribution on her face. She has a history of psoriasis, although in many respects the rash appeared to have features more suggestive of seborrhoeic dermatitis. It was labelled as sebopsoriasis by a dermatologist, a diagnosis that did not exist until recently. The management, using emollients, topical steroids and low-dose antibiotics, was fairly generic in nature, but seemed to work well.


 

Periorbital cellulitis

This 45-year-old man developed mild periorbital swelling. There was no history of trauma. He was diagnosed with an early cellulitis, but did not respond to oral antibiotics. His eye deteriorated over 24 hours and he presented again as shown in the image. At this stage, it was clear that he required admission, where the abscess that had formed was drained. Luckily, his eye and sight were unharmed and he made a full recovery.


 

Trauma

Falls are an increasingly significant and very common problem. The implications, both in personal terms and costs to the nation, for elderly patients sustaining a major injury such as a hip fracture are massive, hence the current focus on identifying 'at-risk' patients. This woman has a peripheral neuropathy and has had many falls, in spite of referral to the local falls clinic. Thankfully, she has not broken anything yet.

 


 

Mumps

Mumps was once a common viral infection, that nearly disappeared. Sadly, the past few years have seen an increase in cases, along with measles, because of the reduction in MMR vaccination. This young man presented with unilateral swelling of his parotid, which was subsequently confirmed to be due to mumps. His main concern was the risk of orchitis, which he had read about on the internet. He was not too ill and recovered fully.


Jaundice

This 90-year-old woman had some non-specific symptoms and had been referred for an ultrasound when she rapidly became jaundiced. This image was taken one month later, by which time her LFTs were grossly deranged. In fact, she had a carcinoma of the pancreas, a disease often presenting relatively late due to the lack of clear symptoms. She only lived a few weeks longer.

  • Dr Marazzi is a GP in East Horsley, Surrey.

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